HomeMy Public PortalAbout6042 CAMELLIA AVE_Plumbing__ APPLICATION FOR PLUMBING PERMIT
1
DIVISION OF BUILDING AND SAFETY
DeparW-nt of Covntr Fny'In ec
County of Los Angel" BUILDING OT w
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,QUFT OF Muami N0
LOCALITY
FR
OR QaC�_ANT 1O FILL N�'�I �o -+u-sir-sto
{N DISTRICT NO. GROUP ONE ■[ADr Fo¢fuF[crlo[
/0 ./
a T
INDUSTRIAL
CITY WAST[APPROVATL�7�pL�t+TT
PLUNBIER / r 1�SPEGTION M=BD
ADDREDD r ' /-"
CITY ✓aw ]] p T9l NO.
N
LICE 491 NO. IA 6 /
XULDiR TYF[OF FRTUIM OR ITd r"
W CLOSET (TOILETr Q 101.00
BATH TUe a 01.00
SHOWER $l.Oo
LAVATORY (WASH 19"IN) 41.00
KITCHEN SINK JjI.00
DII9HWADHHR •1.00
LAUNDRY TUB OR TftAY 41I.GO
CLOTHES W"HER $1.00
WATER HEATER 111.00
GAS lit.00
APPROVALS
DATE IXDPfiCTOR'B SIGNATURE
LIDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
GAD PIPING
TOTAL FEE D GAS VENT
1 HEREBY AC"OwLIZDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRXCT AHD AGREE TO COMPLY HOT WATYR HEATER
WITH ALL COUNTY OHDIXANCES AND STATE LAYS REGULATING E
TURES
PLUMBING.
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AXD/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CAUFORXIA OR THAT 1 THE LEGAL OWX F THE ABOVE OTIFIEDDESCRIBED RESIDENTIAL OPHATY. �SIGNATURIOF PERINITTI<
JOHN A. L_AMBIE. COUNTY ENGINEER VALIDATIO ROBERT A.WOOD, CHIEF PLBG. INHPECI'OR
I 1466.E WT1$h U,.• 2.00 fa
TION
crfflr that
COMPENSATION De of consent
APPLICATION FOR PLUMBING PERMIT
I•hergby, affirm that I have a certlficafe of consent to self In- 20�Otnd�,'�
sure, r a c4llflcate of Workers'Compensation Insurance,or a 764667A
4 Pe CE 817(REV. 8/86)
certlfied copy thereof (Sec-3800, Lab.,C.) 1 t
PoHcy No.—Company ' COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Certified copy Is hereby furnished.
f—F Certified copy Is fl led with the cou Ilding In ct n FOR'�ICA{JT�TO FILL IN(PRINT OR TYPE) BUILDING
.}
LJ department. NLaR FlX7�JRf OR ITEMe FEEL��� (_
Date Appllcan 3 WATER CLOSET(fol ) NEAREST
CERTIFICATE OFq(EMPTION FROM OR T
S'
BATHTUB \ CRO55 ST.
COMPENSATION INSURANCE OV. ER
(Thls sottlort rm d net be compWoo If t}a wgrk In"Ived by R ,
the pormtt Is for one hundred dollars ($100)-or Is".) i-AVpTORY AD IL S iL
DRE
I cerflfy that In the performance of the work for which this per- SINK f 1/ TES tJO
mit Is Issued, (shall nol employ any person In any manner sq Q GN C40
as to become subject to the Workers'Compensation Laws. DISHWASHER
110 CONTRACTOR
Data Applicant CLOTHES WASHER _
NOTICE 7O APPLICANT: If,-cfter making this Cgrtlficpte of Ex• AD-DRESS
emptiort,you'should biome sub ct to the Workers'Compn
e - .�.. POOL ��
i
C1TlLA TEL NO.sbtlon provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM
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ly with such.provisions or this permit shall be deemed revok- STATE !?� UC.
ed WATER HEATER Noapm
LICENSED CONTRACTORS DECLARATION 'DISTRICT By
1 hereby affirm that I am licensed under provJslom of Chapter GAS SYSTEM O(1TLEfS
9(commencingwith Section 7000)of Division 3-)�f the Business5 Ile
OVER
and Profenlons'Code, and my License Is In full force and ef- 5 SYSTEM -FINAL
feVALIDATION
ct. DATE ! ti
License{lumber Eic. Glare T 0
Fl Q
Contractor Date O
• I am exempt under Sec:. W
B.9P.e. forth):'rea,an Plan check fee
oil
PLUMBING PERMLT ISSUING FIBS
Signature
TOTAL FEE
SINGLE FAMILY-
HOME OWNER BUILDER L)ECLARATION Plan check applicant
C
I hereby affirm that I am exempt from the Contractor's License Name 't-
s
Law for the following reason (Section 7031.5,Business and :'�`4_'[•;T
Professions Code): Address
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I--I I, Qs owner of the pro rty, will do the work.and the City Tel. No.. �� 4�c�1
structure is not Intend or offered for sale{Section 7CL",
Business and Professlors Code).
-CONSTRUCTION LENDING AGENCY - I+J���.. 124 -50
I hereby affirm that there Is a construction lending agency for '' 12 �-+)
the petformance of the work for which this permit Is Issued } .[K{
(Sec, 3097, Civ- C-).
tehder's Name4/14/Q7
Lender's Address ! 1 8 [li'
I certify that I have read this apphcatlon and state that the ,
above�lnformatlon Is correct. I agree to comply with all County
ordlnantes. nd State lows rWulating Plumbing, and hereby a
adthorI ntatl f this County to enter upon the
abov tl for Inspectlbn purposes..
SEE REVERSE FOR EXPLANATORY LANGUAGE .
fig nature o P Data